维持性血液透析患者犬尿氨酸与营养状态及血管硬化的关系  

Association of serum L-kynurenine with nutritional status and vascular stiffness in maintenance hemodialysis patients

作　　者：王莉[1] 洪大情[2] 王芳[2] 李鸣[3] 吴姝焜[2] 高辉[2] 王君如[2] 王政通[2] 何强[2] 李贵森[2] 刘章锁[1] 杨秀川[2] 

机构地区：[1]郑州大学第一附属医院肾内科,450052 [2]四川省医学科学院四川省人民医院肾内科暨肾脏病研究所 [3]四川大学公共卫生学院

出　　处：《中华肾脏病杂志》2011年第6期411-415,共5页Chinese Journal of Nephrology

摘　　要：目的研究长期维持性血液透析（MHD）患者血清犬尿氨酸的变化及其与患者营养状态和血管硬化的关系。方法纳入年龄性别相匹配的健康对照、长期服用α酮酸的MHD患者、未服用α酮酸的MHD患者各20例。用高效液相色谱法测定3组的血清犬尿氨酸水平。测定两组MHD患者C反应蛋白（CRP）水平。用主观综合性营养评估（SGA）及炎性营养不良评分（MIS）对两组MHD患者进行营养评估。用脉搏波传导速度（PWV）评估动脉硬化情况。结果MHD患者血清犬尿氨酸水平显著高于健康人[（3．20±1．12）μmol／L比（1．74±0．27）μmol／L，P〈0．011。服用α酮酸组与未服用α酮酸组血清犬尿氨酸水平差异无统计学意义[（3．20±0．88）μmol／L比（3．29±1．34）μmol／L，P〉0．05]。MHD患者血白细胞介素6（IL-6）水平显著高于健康对照组[（6．45±3．78）ng／L比（1．38±1．59）ng／L，P〈0．01]。α酮酸组IL-6水平显著低于非α酮酸组[（3．37±0．82）ng／L比（9．62±2．48）ng／L，P〈0．05]；2组间CRP水平差异无统计学意义。与非α酮酸组比较，α酮酸组SGA评分较高（26．00±1．75比22．67±．61，P=0．001），MIS评分较低（5．82±2．27比10．00±2．62，P=0．002），左、右侧PWV均较低[（21．11±8．21）m／s比（24．57±5．45）m／s，P=0．244；（19．27±．22）m／s比（24．19±5．41）m／s，P=0．015]。相关分析显示，血清犬尿氨酸与血IL-6呈正相关（r=0．352，P=0．011）；与透析前Set呈负相关（r=-0.412，P=O．019）。结论MHD患者普遍存在炎性反应状态，色氨酸代谢产物犬尿氨酸水平可反映这种炎性反应状态。α酮酸可能通过减轻其炎性反应程度从而改善MHD患者的营养、贫血及血管硬化。Objective To study the association of serum L-kynurenine changes with nutritional status and vascular stiffness in maintenance hemodialysis （MHD） patients. Methods Twenty gender- and age-matched healthy volunteers （healthy group） and 40 MHD patients, including 20 cases with α-keto aicd （α-keto acid group） and 20 cases without a-keto aicd （non-α- keto acid group） were enrolled in the study. Serum L-kynurenine was measured by high performance liquid chromatography. C-reactive protein （CRP） and interleukin 6 （IL-6） weredetected. Subjective global assessment （SGA） and malnutrition inflammation score （MIS） were applied to evaluate the nutritional status. Pulse wave velocity （PWV） was used to evaluate arterial stiffness for both groups α MHD patients. Results Serum L-kynurenine was significantly higher in MHD patients than that in healthy subjects [（3.20±1.12） μmol/L vs （1.74-±0.27） μmol/L, P〈 0.01], while such difference was not found between α-keto aicd group and non-α-keto-aicd group [（3.20±0.88） μmol/L vs （3.29±1.34） μmol/L, P〉0.05]. IL-6 was significantly higher in MHD patients as compared to healthy subjects [（6.45±3.78） ng/L vs （1.38±1.59） ng/L, P〈0.01], while such difference was found between α-keto aicd group and non-α-keto aicd group [（3.37±0.82） ng/L vs （9.62±2.48） mg/L, P〈0.05]. There was no difference of CRP concentration between two MHD groups. As compared to non-α-keto acid group, higher SGA score （26.00±1.75 vs 22.67±2.61, P=0.001）, lower MIS score （5.82±2.27 vs 10.00±2.62, P=0.002）, lower left side PWV [（21.11± 8.21） m/s vs （24.57±5.45） m/s, P=0.244] and lower right side PWV [（19.27±3.22） m/s vs （24.19±5.41） m/s, P=0.015] were observed in α-keto aicd group. Pearson analysis showed positive correlation between serum L-kynurenine and IL-6 （r=0.352, P=0.011） and negative correlation between L-kynurenine and pre-dialysis Scr （r=-0.412, P=0.019）. Conclusions Inflammation

关 键 词：血液透析 犬尿氨酸 色氨酸 Α酮酸 脉搏波传导速度 

分 类 号：R692.5[医药卫生—泌尿科学]